Register Now! | Camp Gan Israel of Victoria

Online Registration!

Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.

Note: Please use a separate form for each child.

Camper/Parent Information
Name		First	Middle	Last
Address		Street	City	Province	Postal Code
Date of Birth
Contact Info		Phone	Email
Schools		School	Hebrew School	Entering Grade:
Child's Mother		Mother's Name	Hebrew Name	Work Phone	Cell
Child's Father		Father's Name	Hebrew Name	Work Phone	Cell
Emergency Contact Info		Name	Phone	Relationship
Pediatrician		Name	Phone
Email

Select Child's Age Group
	Ages 3-5			Ages 9-12
	Ages 6-8

Please indicate which session/s your child will attend camp:

		Full Prorgam Tuesday, December 22 - Monday, December 28 FOR RATES CLICK HERE
IMPORTANT
•	All forms must be completed and submitted before your child begins camp.
•	I will be paying by: Cheque - mail a cheque to: Chabad of Vancouver Island #322 - 1095 Meckenzie Ave. Victoria, BC V8P 2L5 Credit card - submit a payment here
	I have read the camp brochure and application form and agree to the terms stated. I give my child permission to attend all trips, and receive medical care in the case of emergency.

	Date of Application: